Right ventricular morphology on catheter angiography: Variations and its implications for the diagnosis of arrhythmogenic right ventricular cardiomyopathy

BackgroundCatheter angiography is one modality used to diagnose right ventricular (RV) structural abnormalities in suspected arrythmogenic right ventricular dysplasia or cardiomyopathy (ARVC) patients. The appearance of the normal RV on angiography is poorly defined. This study aimed to assess RV morphology in a control group to define the range of normal appearances.MethodsRV angiography was performed in 46 subjects (mean age 59 years; 70% male) undergoing coronary angiography for suspected coronary artery disease. Qualitative assessment for RV dilatation, regional wall motion abnormalities (RWMAs), pattern of trabeculae, and presence of micro-aneurysms was performed. Right ventricular outflow tract (RVOT) diameter was measured.ResultsRegional or global RV dilatation was considered to be present in 17 patients, RWMA in 13, an abnormal trabecular pattern in 10, and microaneurysms noted in two. The RVOT diameter ranged from 1.78 to 3.51 cm in right anterior oblique view and 2.33 to 4.38 cm in left anterior oblique view.ConclusionThe apparent prevalence of abnormal RV morphology in individuals who have no known RV pathology implies that detection of such is not necessarily of diagnostic significance in suspected ARVC. Significant inter-observer variation limits the usefulness of qualitative assessment; quantitative assessment is preferred therefore.